Mean Knee Society Function Score Research Articles

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA. Patients who underwent RAUKA for medial compartmental OA were identified from April 2009 to May 2014. The query yielded 162 knees with a mean follow up of 6.5 years. Primary endpoints were to compare survivorship, final mechanical axis alignment, radiographic changes, mean ROM, and changes to the following PROMs: Knee Society Score (KSS), International Knee Documentation Committee (IKDC), and Oxford Knee Score (OKS). Statistical analyses were primarily descriptive. A p-value less than 0.05 was considered statistically significant. There were no revisions of the primary implant, one case required exchange of polyethylene bearing and debridement for deep infection, and five cases required additional surgical intervention with implant retention. Overall survivorship was 100%. Radiographic assessment demonstrated no mechanical loosening or osteolysis surrounding the implant. Mean ROM was 3 to 121.9º. Patients demonstrated a mean functional KSS of 78.55, IKDC of 78.22, and OKS of 43.94. The study supports excellent mid-term outcomes in patients undergoing RAUKA for medial compartment OA. Longer term follow-up studies are necessary to determine the efficacy of this technology for patients undergoing RAUKA for medial compartment OA.

COMPARATIVE STUDY OF POSTERIOR STABILIZING VS CRUCIATE RETAINING PROSTHESIS IN TOTAL KNEE REPLACEMENT

Introduction: There has been a continuing debate regarding whether the posterior cruciate ligament should be sacrificed or retained at the time of total knee arthroplasty.It is still controversial which approach is superior because both cruciate retaining prosthesis and posterior stabilizing prosthesis have advantages and disadvantages. Materials and Methods: A cross sectional analytical study was conducted on 37 patients (20 in Posterior Stabilized group and 17 in Cruciate Retaining group) fulfilling the inclusion and exclusion criteria. The follow up was done at 1, 3 and 6 months during which functional outcome was compared using American Knee Society Score and associated complications were also compared. Results: At 6 months, the mean Knee Society Knee scores in Posterior Stabilized Group and Cruciate Retaining group were 91.05 ± 3.53 and 90.12 ± 3.57 respectively and mean Knee Society Functional scores were 89.75 ± 4.44 and 88.52 ± 4.24 respectively. The mean Knee Society Knee Score and Functional Score in both the groups were statistically not significant at pre-operative, 1 month, 3 months and 6 months as revealed by insignificant p value (>0.05). There were 3 complications in Posterior Stabilized Group which were 1 case of knee stiffness, 1 infection and 1 tibiofemoral subluxation. There were 2 complications in Cruciate Retaining Group which were 1 case of anterior knee pain and 1 periprosthetic proximal tibia fracture. Conclusions: Although, both the groups individually had significant improvement in regards to function from pre operative status to post operative status, there was no statistically significant difference in clinical and functional outcome between the two groups when compared with each other. However, the Posterior Stabilizing Total Knee Arthroplasty had better Range of motion score throughout the study. The complications associated with both the groups were comparable.

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA. Patients who underwent RAUKA for medial compartmental OA were identified from April 2009 to May 2014. The query yielded 162 knees with a mean follow up of 6.5 years. Primary endpoints were to compare survivorship, final mechanical axis alignment, radiographic changes, mean ROM, and changes to the following PROMs: Knee Society Score (KSS), International Knee Documentation Committee (IKDC), and Oxford Knee Score (OKS). Statistical analyses were primarily descriptive. A p-value less than 0.05 was considered statistically significant. There were no revisions of the primary implant, one case required exchange of polyethylene bearing and debridement for deep infection, and five cases required additional surgical intervention with implant retention. Overall survivorship was 100%. Radiographic assessment demonstrated no mechanical loosening or osteolysis surrounding the implant. Mean ROM was 3 to 121.9º. Patients demonstrated a mean functional KSS of 78.55, IKDC of 78.22, and OKS of 43.94. The study supports excellent mid-term outcomes in patients undergoing RAUKA for medial compartment OA. Longer term follow-up studies are necessary to determine the efficacy of this technology for patients undergoing RAUKA for medial compartment OA.

Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis.

The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. We retrospectively studied a total of 46 type Y-L-Q PFAs that were designed at our institution in 38 patients. Implant survivorship was analyzed with a follow-up of 18.9-29.6years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. The implant survivorship was 83.6% at 15years, 76.8% at 20 years, and 59.4% at 25years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7years; 13 for progression of tibiofemoral osteoarthritis and one for polyethylene wear. The mean Knee Society Score objective scores and functional scores were 73.0 ± 17.5 (range, 49-95) and 56.4 ± 28.9 (range, 5-90), respectively. The mean Oxford Knee Score was 25.8 ± 11.5 (range, 8-44). Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.

Total knee arthroplasty versus unicompartmental knee arthroplasty in management of anteromedial knee osteoarthritis: a randomized clinical trial

Background: Both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are options to manage anteromedial knee osteoarthritis. This study’s aim was to determine the functional outcome, time taken to walk without support, and postoperative complications after either TKA or UKA in treatment of anteromedial knee osteoarthritis. Methods: A prospective randomized cohort study was performed at a level 1 academic center on 60 patients with a mean age of 56.2 yr who had isolated anteromedial knee osteoarthritis. Thirty patients were managed by UKA (group 1), and the other 30 patients were managed by TKA (group 2). Diagnosis was confirmed by plain radiographs (anteroposterior standing, lateral, skyline, stress varus, and valgus views). Follow-up was done for at least 12 mo postoperatively. Results: Mean preoperative functional Knee Society Score (KSS) was 65.83 and 62.67 for group 1 and group 2, respectively. Mean functional KSS after 1 yr was 86.3 for group 1 and 84.6 for group 2. In group 1, one patient developed lateral joint line pain, and another patient developed postoperative blood loss of more than 400 mL. In group 2, one patient developed patellofemoral pain, and another patient developed postoperative blood loss of more than 400 mL. The mean time that it took for patients to walk without support was 1.6 wk in group 1 and 1.93 wk for group 2. Conclusions: Both UKA and TKA have the same functional outcome for treatment of anteromedial knee osteoarthritis and the same rate of complications, but early postoperative rehabilitation is better in patients managed by UKA. Level of Evidence: Level I.

Pre-operative use of CT based three-column concept for fragment specific fixation of proximal tibia fractures in a series of 84 cases

Background: It is important to classify proximal tibia fractures based on CT scan in addition to plain radiograph. The 3-column concept was introduced to classify these fractures based on a transverse CT scan. This study aimed to evaluate the surgical and functional outcomes of fragment specific fixation in proximal tibia fractures using the 3-column concept. Materials and Methods: 84 cases of proximal tibia fractures (mean age: 42.85±11.94 years, range 23-72 years; 65 males and 19 females) were classified based on the 3-column concept (24 - 1 column, 50 – 2 column, 10 – 3 column). The surgical approach was decided for fragment-specific fixation based on the column involved. The clinic-functional assessment was done using fracture union time, range of motion, Oxford Knee Score and Functional Knee Society Score. Results: The mean follow up duration was 1.2-1.5 years. The average fracture union time was 15.63±1.98 weeks (range, 12-21 weeks). The mean flexion achieved at the final follow up was 132.74±4.49 degrees (range, 130-135 degrees). The mean follow-up Oxford Knee Score was 47.98±0.109 (range, 45-48) and the mean Functional Knee Society Score was 99.88±1.09 (range, 90-100) in all patients after 1 year. 2 patients showed they delayed wound healing with superficial infection and 1 patient had a stiff knee. There was no other complication. Conclusion: Using the CT-based three-column concept for fragment-specific fixation pre-operatively helps treat a complex proximal tibia fracture with acceptable complication rates and good functional outcomes.

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

IntroductionRevision knee arthroplasty presents a number of challenges, including management of bone loss. The goal in managing moderate to large bone defects is fixation that is sufficient enough to allow early weight-bearing. The purpose of this study was to describe the surgical technique and clinical and radiographic outcomes of patients treated with porous tantalum metaphyseal cones in combination with long uncemented diaphyseal-engaging stems to manage tibial bone loss in revision total knee arthroplasty (TKA).Materials and methodsThirty-six aseptic revision TKAs were performed at our institution between 2016 and 2019 by two senior authors. A single trabecular metal tantalum cone combined with a long (100 or 155 mm) press fit, diaphyseal-engaging stem was used in all cases to reconstruct metaphyseal bone defects and to augment tibial fixation. Cemented stems were excluded. The tibiofemoral angle was measured along the tibial and femoral shaft axes on the weight-bearing anteroposterior radiograph at final follow-up (range 15–56 months). All clinical and surgical complications, reoperations, and revisions of any component were recorded. Survivorship free of revision was evaluated at the time of the latest follow-up.ResultsThe mean Knee Society Score (KSS) and Knee Society Function Score (KSS-F) improved significantly from 29.7 points preoperatively (range 11–54 points) to 86 points (range 43–99 points) and from 20.4 points preoperatively (range 0–55 points) to 72.3 points (range 30–90 points) (p < 0.05), respectively. Eleven tibial constructs (30.5%) had incomplete, nonprogressive radiolucent lines (≤ 2 mm). All tibial cones demonstrated osteointegration. One patient underwent a full revision for periprosthetic joint infection, and survivorship free of any component revision was 91.7% at final follow-up.ConclusionsHybrid fixation with uncemented diaphyseal-engaging stems and porous tantalum metaphyseal cones resulted in radiographic lack of osteolysis, good clinical outcomes, and survivorship of 91.7% at a median follow-up of 33 months when considering all-cause revision as the endpoint.

Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty

Background: Some surgeons decide to preserve or sacrifice PCL preoperatively based on their experience and training, while others decide intraoperatively after evaluating morphology of PCL, knee alignment, range of motion (ROM) and stability of knee. Several papers have been published comparing outcomes of PCL-retaining and PCL-stabilizing types of prostheses in neutrally aligned knees. Some potential advantages of cruciate-retaining prosthetic designs include preservation of bone, more normal knee kinematics, increased proprioception, femoral rollback on the tibia during flexion, and greater stabilization of the prosthesis, with the PCL preventing anterior translation of the femur on the tibia. Aim of the study: To compare posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. Materials and methods: For the study, a total of 60 patients underwent total knee arthroplasty utilizing a posterior-stabilized prosthesis, and another group of 60 patients received a cruciate-retaining implant. All patients who had osteoarthritis, osteonecrosis, or rheumatoid arthritis and who were indicated for a total knee arthroplasty were invited to take part in a prospective study to follow their outcomes. The patients were evaluated in the office one month after the procedure and annually thereafter. The ranges of motion, Knee Society scores, radiographic outcomes, and complications were assessed at each follow-up visit, and these were compared at the five-year follow up. Results: We observed that the mean Knee Society knee scores of the Group 1 was 80 and for Group 2 was 75. The mean Knee Society functional scores were 67 points for Group 1 and 78 for Group 2. The mean ranges of motion were 132° for Group 1 and 125° for the for Group 2. The results on comparison were found to be statistically non-significant. Conclusion: Within the limitations of the present study, it can be concluded that posterior cruciate-retaining versus posterior stabilized total knee arthroplasty offers significant benefits postoperatively; however, on comparing both the procedures provide similar results.

Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

BackgroundThe purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability.Materials and methodsA consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees.ResultsAt a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension.ConclusionCCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants.Level of evidence Therapeutic study, level IV.

Comparative study of outcome between posterior-stabilized versus posterior cruciate ligament-retaining total knee arthroplasty

To compare the functional outcome of Posterior stabilized and Posterior Cruciate retaining total knee arthroplasties done at a tertiary care centre like Government Medical College Thiruvananthapuram. We also study and compare the Incidence of complications including surgical site infection, hematoma formation and neurovascular injury in the different techniques. Posterior-stabilized and posterior cruciate retaining total knee arthroplasty prostheses have had high success rates, but it is unclear whether one design has superior outcomes. The purpose of the present study was to directly compare the outcomes of these two designs. Forty- five patients who received a posterior-stabilized prosthesis were compared to 46 consecutive patients who received a cruciate-retaining implant. At a mean follow- up time of 60 months (range, 49 to 69 months), the mean Knee Society knee scores improved from 38 points (range, 20 to 73 points) to 88 points (range, 39 to 100 points) for the cruciate-retaining group and from 38 points (range, 20 to 70 points) to 90 points (range, 60 to 100 points) for the posterior-stabilized group. The mean Knee Society functional scores improved from 32 points (range, 10 to 60 points) to74 points (range, 15 to 100 points) for the cruciate-retaining group and from 32 points (range, 10 to 70 points) to 72 points (range, 32 to 100 points) for the posterior-stabilized group. The ranges of motion were 125° (range, 100 to 140°) and 118° (range, 87 to 135°) in the cruciate-retaining and posterior-stabilized groups, respectively, at final follow-up. Radiographic analysis revealed no radiolucencies that were progressive or were greater than 1 millimeter in length. There were no re-operations in either group. This study did not conclusively demonstrate the superiority of one knee design over the other, suggesting that the choice of implant should be based on surgeon preference and existing pathology of the posterior cruciate ligament.

Medulloscopy-Assisted Surgery for Osteonecrosis of the Knee Following Treatment for Adolescent Leukemia: Mid-term Results.

This study aimed to introduce the medulloscopy-assisted autologous bone graft for osteonecrosis of the knee following adolescent leukemia treatment and to report the mid-term clinical and radiological results. We retrospectively reviewed records of eight consecutive knees in six patients with extensive osteonecrosis of the distal femoral condyles, from 2013 to 2015. All patients were treated with autologous bone grafts using medulloscopy. We evaluated functional and objective Knee Society Score (KSS) pre- and postoperatively. Clinical and radiological outcomes were evaluated at the last follow-up. The mean age of the patients at the time of surgery was 21.5years. The mean follow-up period was 45months. No additional surgery was required during the follow-up period. The mean objective KSS significantly increased from 60.6 points (range 55-65) to 90.0 points (range 70-95), postoperatively (p < 0.001). The mean functional KSS significantly improved from 48.8 points (range 45-55) to 90.0 points (range 80-100) postoperatively (p < 0.001). No patients had progression of collapse of the femoral condyles at the final follow-up. At the final follow-up, the onset of minimal osteoarthritis was seen in two knees, with a Kellgren-Lawrence grade 1. Medulloscopy-assisted bone grafting can be an effective treatment option for early symptomatic osteonecrosis of knee following treatment for adolescent leukemia.

Erratum: Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach

Total knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42–78 years). Follow-up duration was a mean of 47.3 months (range: 3–130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3–42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6–15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.

Comparison of Posterior Cruciate-Retaining and High-Flexion Cruciate-Retaining Total Knee Arthroplasty Design

BackgroundHigh-flexion prostheses have been developed to achieve deep flexion after total knee arthroplasty. The purpose of this study is to compare standard NexGen (CR, cruciate-retaining) and high-flexion NexGen (CR-flex) total knee prostheses in terms of range of motion, clinical and radiologic outcomes, rates of complications, and survivorship in long-term follow-up. MethodsFrom January 2000 to December 2008, 423 consecutive knees underwent total knee arthroplasty using standard CR or CR-flex prostheses. Fifty-three patients were lost to follow-up or declined to participate and 54 died, leaving 290 knees. The minimum duration of follow-up was 8 years (mean 10.1 years). Physical examination and knee scoring of patients were assessed preoperatively, at 6 months and 1 year after surgery, and annually thereafter. Supine anteroposterior and lateral radiographs and standing anteroposterior hip-to-ankle radiographs were obtained preoperatively and at each follow-up. ResultsMean postoperative range of motions in the standard CR group and the CR-flex group were similar, showing no significant difference between the 2 groups (P = .853). At the time of the final follow-up, mean total Hospital for Special Surgery scores were similar between the 2 groups (P = .118). Mean Knee Society pain (P = .325) and function scores (P = .659) were also comparable between the 2 groups. Western Ontario and McMaster Universities Osteoarthritis Index score showed no intergroup difference either (P = .586). The mean hip-knee-ankle angle at the final follow-up was approximately the same (P = .940). Mean coronal angles of femoral and tibial component at final follow-up were also similar (P = .211 and P = .764, respectively). The prevalence of the radiolucent line was 0.6% in the standard CR group and 0.9% in the CR-flex group. Estimated survival rate according to Kaplan-Meier survival analysis was 97.2% in the standard CR group and 95.6% in the CR-flex group at mean follow-up of 10.1 years. ConclusionThis study suggests that excellent clinical and radiographic outcomes could be achieved with both standard and high-flexion CR total knee designs. High-flexion CR prosthesis did not show any advantages over the standard design.

Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up

BackgroundThe reconstruction of severe bone loss utilizing porous tantalum cones in patients undergoing revision total knee arthroplasty (TKA) has been established in the last years. However, reports on a long-term follow-up to assess the durability of such implants when combined with hinged knee designs are lacking. The current study aimed to evaluate the results of a previous study cohort at a minimum follow-up of 10 years. MethodsA retrospective review was performed. The initial study cohort comprised of 38 patients who underwent aseptic revision TKA between 2007 and 2009 at a single institution. After exclusion of the deceased patients and patients who were lost to follow-up, 25 patients with hinged knees and 32 cones implanted were included with a minimum follow-up of 10 years (mean = 126.5 months, range 120-142, standard deviation [SD] = 5.92). Survivorship was determined, and re-revisions were observed. Functional Knee Society Score was assessed. ResultsAfter a minimum of 10 years, 24 of 32 cones (75%) had survived without any exchange in 18 patients. Reasons for cone revision included aseptic loosening (5/32 cones; 15.6%) and periprosthetic joint infection (3/32 cones; 9.4%). In 4 of the five revisions due to aseptic loosening, pure hinged knees had been implanted. The mean functional Knee Society Score of the survivors was 69.6 points (range 10-100, SD = 30.85), and the average flexion ability of the knee was 92° (range 30°-120°, SD = 22.09). ConclusionPorous tantalum cones in revision TKA exhibited no favorable but reasonable long-term durability. Rotating-hinge designs should be used whenever possible to reduce the risk of aseptic loosening. Further comparative long-term analyses with other techniques or implants could inform us about the best treatment method.

Managing of post-traumatic knee arthritis by total knee arthroplasty: case series of 15 patients and literature review

PurposePost-traumatic arthritis is one of the leading causes of joint disability. This study aims at outlining outcomes of total knee arthroplasty in post-traumatic arthritis and technical difficulty and reviewing literature regarding this issuePatients and methodsWe analyzed the outcome of total knee arthroplasty following post-traumatic arthritis in 15 patients with unilateral involvement. Ten had stable arthritic knees treated with posterior stabilized (PS) prosthesis, while five with unstable arthritic knees treated as follows: three with ligamentous instability managed by constrained condylar prosthesis and two with osseous deficiency, metal augmentation used together with stemmed constrained condylar prosthesis (CCK). Average follow-up 6 years, mean age 49.8 years at time of arthroplasty. Patient outcomes were evaluated on the basis of Knee Society score.ResultsMean clinical knee society scores (CKSS) at latest follow-up improved from 43.6 ± 11.66 points to 77.3± points postoperatively while mean functional knee society score (FKSS) improved from 40. ± 6.3 to 76.6 ± 84 postoperatively. Patients with stable knees had a higher mean values, both clinical and functional KSS, while unstable knees were poorer. Complications occurred in three cases, one with wound dehiscence with prolonged drainage treated by antibiotics and daily dressings until the wound closed completely, one was complicated by infection and improved by serial debridement, and the third case had aseptic loosening which required revision surgery.ConclusionTotal knee arthroplasty for post-traumatic arthritis decreases pain and improves knee function. However; the procedure is not as simple as primary arthroplasty as it is technically demanding and requires adequate planning.

Synthetic Mesh Allograft Reconstruction for Extensor Mechanism Insufficiency After Knee Arthroplasty.

Extensor mechanism (EM) insufficiency after knee arthroplasty is a rare but devastating complication resulting in severe disability. To date, primary repair and allograft reconstructive options have produced suboptimal results. A synthetic mesh allograft reconstruction technique has recently been introduced with promising outcomes. A retrospective chart review was performed to identify all patients who experienced EM failure after total or unicompartmental knee arthroplasty and subsequently underwent synthetic mesh EM reconstruction using a previously described technique. Patient demographics, pre- and postoperative knee range of motion and residual extensor lag, pre- and postoperative pain and functional outcome scores, and complications were extracted during the chart review. Twelve patients met inclusion criteria: 3 with patellar tendon and 9 with quadriceps tendon defects. At mean follow-up of 27.0 months, all patients were ambulatory, with a mean residual extensor lag of 12.9° (range, 0°-30°). Mean visual analog scale pain score decreased significantly after EM reconstruction: 4.6±2.3 (range, 1-8) preoperatively vs 1.8±2.4 (range, 0-7) postoperatively (P=.01). The mean Knee Society knee score improved from 41.5±11.1 (range, 21-57) preoperatively to 79.5±13.8 (range, 54-90) postoperatively (P<.0001). The mean Knee Society function score improved from 14.6±12.3 (range, 0-40) preoperatively to 64.2±27.1 (range, 5-95) postoperatively (P<.0001). One clinical failure occurred as a result of prosthetic joint infection. Synthetic mesh EM reconstruction effectively restores knee function for a variety of EM deficiencies following knee arthroplasty. [Orthopedics. 2019; 42(4):e385-e390.].

Clinical and functional outcome of posterior cruciate ligament retaining total knee arthroplasty

Introduction: Posterior Cruciate Ligament (PCL) retention achieves an increased potential range of motion by effective femoral roll back and a relatively flat tibial articular surface in Total Knee Arthroplasty.Objective: To study the clinical and functional outcome of patients who undergo posterior cruciate ligament (PCL) retaining total knee arthroplasty.Methods: The purpose was to determine the clinical and functional outcome during the acute and midterm (One year) follow up after posterior cruciate ligament retaining total knee arthroplasty (CR TKA). Thirty patients scheduled for CR TKR were evaluated preoperatively, 1 month, 3 months, 6 months and 12 months postoperatively using the knee society clinical and functional scores.Results: The mean pre- operative knee society clinical and functional scores of the 30 cases were 36.5 (Ranging from 20 to 64) and 31.8 respectively. The mean knee society clinical score at the 1st follow up was 76.5, at the 2nd follow up was 83.5, 3rd follow up was 88.6 and 4th follow up was 92.4. The mean knee society functional score at the 1st follow up was 72.5.5, at the 2nd follow up was 80.5, 3rd follow up was 87.5 and 4th follow up was 90.6.Conclusion: We found out that twenty nine out of thirty patients undergoing TKR had excellent clinical and functional scores; one patient had good functional scores at the end of one year. More than 90% of patients in our study had excellent functional scores at the end of one year. Posterior cruciate ligament retaining total knee arthroplasty is a good surgical option for osteoarthritis of knee.

Metaphyseal Fixation Using Highly Porous Cones in Revision Total Knee Arthroplasty: Minimum Two Year Follow Up Study

BackgroundHighly porous metaphyseal cones have been introduced to restore metaphyseal integrity for improved cement interdigitation to achieve durable fixation in revision total knee arthroplasty (TKA). The purpose of this study is to review the survivorship, clinical results, and complications of revision TKA using highly porous 3-dimensionally printed titanium metaphyseal cones. MethodsThis is a review of 62 revision TKAs using metaphyseal tibial cones, with 15 cases utilizing both tibial and femoral cones. The mean age of the patients was 66 years (range 32-84) who had a mean follow-up of 27 months (range 24-34). There were 38 women and 24 men, who had a mean body mass index of 33 (range 18.3-62). ResultsRevision-free survival of the cones was 90.2%. If infection was excluded, survivorship was 100%. There were no cases of aseptic loosening. The mean Knee Society Score improved from 51 points preoperatively to 80 points at the time of latest follow-up. The mean Knee Society Functional Score improved from 48 points preoperatively to 68 points. A total of 15 of the 62 patients (24%) required additional surgery: 10 (16%) for infection, 3 (5%) for contracture, 1 for patellar subluxation, and 1 for quadriceps tendon rupture. ConclusionMetaphyseal fixation is important for survivorship in revision TKA which can be challenging due to cancellous and structural bone loss encountered at the time of revision. Prosthetic joint infection continues to be the leading cause of failure in revision TKA. The use of highly porous titanium metaphyseal cones produced from 3-dimensionally printed technology used in this study demonstrated excellent short-term results with no cases of aseptic loosening. Further follow-up is required to determine if these results can be durable over a longer period.

Interprosthetic Femoral Sleeves in Revision Arthroplasty: A 20-Year Experience

BackgroundInterprosthetic femoral fractures in patients with ipsilateral stemmed total hip arthroplasty (THA) and total knee arthroplasty (TKA) can be technically demanding to treat surgically. Nonunion and implant failure are among the main complications following fixation of interprosthetic femoral (IF) fractures. Total femoral arthroplasty (TFA) is associated with a high incidence of infection and instability. IF sleeves have been designed to avoid the disadvantages of these techniques and to provide a stable construct. The aim of this study was to present the results with this device from a single center. MethodsWe reviewed 26 patients who underwent revision arthroplasty procedures, using custom-made cemented IF sleeves between 1997 and December 2017 in our institution. Two-part sleeves were used in 18 patients and one-part sleeves in 8 patients. The most common indication was an IF fracture (18 patients). Patients were monitored for postoperative complications, implant failure, and re-revision. The minimum follow-up of the survivors with nonrevised sleeves was 12 months. ResultsTwenty-three patients were included for the final analysis. The mean survivorship of the IF sleeve was 4.6 years at latest follow-up (mean 48.5 months; range 12 to 156). The overall rate of complications was 47.8%. The rate of mechanical failure was 21.7%. Late infections occurred in 3 patients (13%). At the latest follow-up, the mean Harris Hip Score was 69.9 points (range 39 to 94), and the mean functional Knee Society Score was 42.5 points (range 0 to 90), with average knee flexion of 95° (range 90° to 100°). ConclusionThe IF sleeve is a valid technique for the management of selected patients with IF fractures, particularly when a stable fracture fixation is not possible. Hip instability is not a concern, and functional improvement is achievable. Careful planning is required preoperatively to avoid mechanical failure.

Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach.

Total knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42-78 years). Follow-up duration was a mean of 47.3 months (range: 3-130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3-42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6-15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.